Juxtaposition
Volume 2 | Issue 1 | Fall 2007
Storm in a Western Pill Fear and Empowerment in ADHD Drug Treatment By Shane Wong
“Ritalin, Ritalin, seizure drugs, Ritalin.” Such is the lunchtime rhyme for a typical school nurse in the U.S. as she trots from class to class, dispensing pills into outstretched hands of young children (01/18/99 – New York Times).
Welcome to the uniquely North American psychotropic environment. A continent featuring a prescription drug market for attention deficit hyperactivity disorder (ADHD) worth over US$2 billion annually, and where the number of prescriptions have grown four-fold in 20 years and over 90% of prescriptions worldwide originate.1 But when patients as young as two-years-old are prescribed drugs that a government puts in the same category as morphine and cocaine,2 controversy concerning the use of drug treatment for ADHD is bound to arise. This article will explore how ADHD medication can empower diagnosed patients, and why fears towards such drugs and the pharmaceutical industry persist across North America.
ADHD Diagnosis Attention deficit hyperactivity disorder (ADHD) is among the most commonly diagnosed behavioural disorder in school-aged children, with prevalence rates ranging from 2% to 7%.3 According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), the standard diagnostic manual for all North American mental health professionals, ADHD is differentiated into two clusters of behavioural symptoms: inattention as well as hyperactivity and impulsivity.4 Problems with attention primarily involve a lack of sustained focus, which can manifest as a rapid shift between toys when young children play or a lack of persistence shown by older children during tasks that lack intrinsic appeal or immediate reward. Additionally, children may also have trouble controlling impulsive behaviour, such as speaking out irrationally or engaging in unnecessary risk-taking behaviour. Finally, hyperactivity includes a tendency to fidget excessively, making it often the most obvious featuren young children. Burden of Disease: In the Classroom These tendencies naturally contribute to problems in a variety of domains for many children classified as having ADHD. Academically, children with ADHD are more likely to be expelled or suspended. 25% of ADHD children develop learning disabilities that range from reading disorders to dyscalculia, a very specific math related disorder where individuals have trouble manipulating simple calculations and numbers.5 Consequently, it is no surprise that researchers found that ADHD is associated with lower rates of high school graduation and post-secondary education. Burden of Disease: Outside the Classroom Apparently the sing-song echo of children in the playground, “sticks and stones may break my bones, but words will never hurt me”, is only partly true. ADHD children not only have higher rates of accidents, but they have a lower sense of self-esteem and self-efficacy due to frequent negative feedback in academic and social settings.6,7 More troublingly,
one study found that 30% of ADHD youth also suffer from anxiety disorders, while 11% experience major depression. Due to their often unrestrained and overbearing social behaviour, ADHD children are also less popular among their peers. Using their classmates’ ratings, researchers found that only 1% of 7-9 year-old children with ADHD were of ‘popular’ status, while 52% fell into the ‘rejected’ category.8 A Childhood Syndrome? Contrary to popular belief, many of the symptoms of ADHD remain present throughout an individual’s lifetime. With growing attention shifting towards adults with ADHD, researchers have found that many negative outcomes associated with ADHD that are exacerbated in adulthood as individuals are gaining increasing responsibility and autonomy. Adults with ADHD generally face greater marital and drug abuse problems, and become involved in more serious accidents. For instance, a unique German study revealed that nearly 45% of inmates in a prison facility suffer from ADHD, suggesting an increased risk of run-ins with the law.9 Furthermore, at the workplace, ADHD adults display lower work ratings and often change jobs more frequently.10 Ritalin: An Empowerment Tool? Given the negative health, social and academic outcomes associated with ADHD, psychostimulant medications such as Ritalin and Adderall offer the potential to empower children and adults by reducing the risk of negative consequences. In a landmark study lasting over 18 years, researchers at the renowed Mayo Clinic found that ADHD medication was associated with improved long-term academic success in children with ADHD. Compared to untreated children diagnosed with ADHD, medication improved reading achievement scores, decreased absenteeism, and decreased the likelihood for a child to be retained in a grade.11 More specifically, children were able to handle general tasks and manage requests better, while increasing academic productivity. Outside the classroom, treatment with psychostimulants also reduced the risk of substance abuse by about half compared to children without treatment.12 The growing research into the benefits of psychostimulant treatment suggest that current ADHD medications can empower individuals to achieve success in academic, employment, self-care and social relationships. But, how does this ‘magic’ pill work? With advances of brain imaging technology, researchers have made tremendous progress in illuminating how medication ‘empowers’ at a neurochemical level. Contrary to one of the first coherent descriptions of ADHD in 1902,13 which attributed the disorder to an “abnormal defect in moral control,” current drug treatments have actually uncovered a characteristic difference in the brains of patients with ADHD, which stems from a lack of dopamine receptors in the attentional network. Therefore, ADHD psychostimulant treatments, like Ritalin, actually
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